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PHS-EHD - UNDERf IUND TANK CLOSURE/ABANDONh T INSPECTION <br /> (SHADED AREA 1,,./,y BE FIyL/L�EDI yN�/ FOR THE FIRST TANK ONLY)AA <br /> ��',' �� .Ui.'c'd1�.i�izv""J�Iri '�.�i1v��.�i�JZlv.fli Iv'y •' , , �rv��. , ,.11i�•v7irJli�,vi'�.rli� L:�v�'1/r��� r a <br /> f OWNER NAME �l, OWNER PHONE <br /> N CONTRACTOR \ � <br /> E "G SCCI 'zz�� 5 � CON. PHONE# ��4 cf✓ �/ "�3 3� f',, <br /> R ` SJLHD PERMIT #, EPA # FIREPERMIT # <br /> , <br /> J <br /> INSPECTORX1iDATE l-(�fj/ TANK # .,9 <br /> R RINSED (Y/N) METHOD <br /> I RINSE AMOUNT <br /> N RINSATE DISPOSAL SITE <br /> S ' <br /> E MANIFEST # -OR- OTHER <br /> V VAPORS PURGED .oi METHOD <br /> A AMOUNT USED <br /> L. E. L. READING AT REMOVAL (MUST BE ( 20%) <br /> T R COMMENTS <br /> A <br /> K C TANK MATERIAL ��EL, , FIBERGLASS, OTHER) TANK SIZE <br /> / 0 TANK CONDITION , ODS POOR, HOLES) <br /> N A ► fw ccttd— <br /> S PIPE MATERIAL (STEEL, FIBERGLASS, OTHER) # FEET <br /> P T <br /> I PIPING CONDITION (GOOD, POOR, HOLES) <br /> N <br /> G DEPTH SOIL TYPE OBSERVATION <br /> F T -7SAMPLE # <br /> A <br /> I N <br /> E K <br /> L I �' vJ f'1 G7� 3 <br /> D - : X �> . <br /> EXCAVATION SIZE <br /> S X YDS OF SOIL: <br /> I A DEPTH SOIL TYPE OBSERVATION <br /> N M P SAMPLE # <br /> S P I <br /> P L P <br /> E I E <br /> C N <br /> T G TRENCH DIMENSION X X <br /> I YDS Of- SO I L <br /> 0 H DEPTH TO G. W. <br /> N FT SAMPLING METHOD <br /> G # OF HOURS SINCE DEWATERING: <br /> 0 OTHER SAMPLE: <br /> LABORATORY: SAMPLERS NAME: <br /> CLOSURE IN PLACE MIXTURE: <br /> VOLUME: <br /> iEH 23043 ( 10/89) DRAW SITE MAP ON REVERSE <br />